| YOUR DETAILS |
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| First Name : |
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Last Name : |
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| Address : |
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| Town / City : |
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| Postcode : |
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| Mobile : |
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| Email : |
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PREFERED CONTACT
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| ARE YOU INTERESTED IN |
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| Learning more about the bible ? |
| Being part of a House Group ? |
| Learning more about The Church ? |
| Receiving our Newsletter regularly ? |
| Becoming a member of The Church ? |
| Learning who Jesus is ? |
| DO YOU NEED |
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| Assistance of some kind ? |
Prayer for a specific need or situation ? |
| HOW DID YOU HEAR ABOUT THE CHURCH ? |
| Public Advert |
Newsletter |
The Web |
| Flyer |
Poster |
| Other - please specify : |
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HOW WOULD YOU DESCRIBE
YOUR FIRST IMPRESSION OF THE CHURCH ? |
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| IS THERE ANYTHING YOU WOULD LIKE TO SEE AT THE CHURCH ? |
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